We don’t hear much news about “The Affordable Care Act” (Obama Care) these days. Although when we do, we are told that it’s working just fine and many Americans who were previously uninsured now have insurance. I don’t know what’s going on in other states but I follow the Covered California Face Book page, and everyday there is another “satisfied” customer posting a complaint.

Some of the complaints are about long wait times to speak with a Covered California (CC) representative. It was believed that CC reps were laid off after the enrollment period, but today someone from CC finally admitted, “… due to a high volume of complaints…,” there will be long wait times for those lucky enough to get in the queue.

Other major complaints are:

1. Monthly premiums are too high. The average deductible is $6,000 a year per family member. (The reason people didn’t see the doctor before this law went in to effect is because they couldn’t afford to go. Now they have to come up with the money for the office visit, prescriptions and pay monthly premiums?)
2. Consumers cannot find doctors willing to take the CC insurance.
3. Those who did find doctors who will take CC insurance, and need surgery or a procedure done, discover that the hospital the doctor is contracted with, is not in their “network plan.”
4. People who were told by CC they qualify for Medi-Cal do not have their insurance cards yet, or have yet to receive a letter from Medi-Cal stating they are working on their case.
5. Some who were told by CC they qualify for Medi-Cal, later find out they do not qualify. CC suggested they complain to “California Department of Managed Healthcare” (in fact that is the default message for all complaints coming in to CC Face Book page.) Here are two responses from Medi-Cal social workers from CC’s Face Book page:

Allison A. wrote, “Oh coveredca, you’ve tried so hard to set counties up for failure. The huge delay in the process is that the existing eligibility systems in the county offices are receiving huge amounts of external referrals that typically work well when there is no known case for the applicant. If there is already an existing case in our eligibility system, you essentially have to go over the case with a fine toothed comb and troubleshoot the case through trial and error to see what will finally make the cases work.

Cases are broken. It’s not that there are more applications than were expected (at least not in solano county). It’s that the systems speak different languages, the minimal training provided by CoveredCA was useless because they have a completely different interface that they work from than what counties work from, and medi-cal business rules are not allowed to be built into our eligibility systems.

Sure, coveredca said you’re eligible based on what you input into their system. After we receive the referrals, we have to go through and review what was input to verify that the information is correct. We are eligibility workers, coveredca representatives are not. We know the intricacies of the various Medi-Cal programs and their regulations, we know that you CANNOT COUNT YOUR PG&E BILL as a monthly income deduction.

If you want answers, come in and re-apply in person at your local Health & Social Services office. They can check their external referrals and register your application back to that date.”

Brenda S. added, “Im an eligibility worker in county 36 we are so backlogged…. I understand your frustration 100%! There is people putting diapers and groceries as expenses so of course they are eligible to Medi-cal and so we get the referral but turns out that we dont allow those expenses….. Yes if you qualify for medical please apply online though your county website or go in the office pick up an app. Fill it out at home then send it by mail.”

We were also told that CC would help prevent people from using the emergency rooms as their doctor office, therefore shortening wait times for those who really need to be there. The average ER wait time is now 6-8 hours. People still show up at the ER instead of seeing a doctor or going to Urgent Care.

There are many more different complaints coming in daily, but these are the most common ones. If the message coming from government is that more Americans are insured, then the message is correct, but from what I read, Americans are not getting healthcare. Isn’t that why the ACA was established in the first place? Or was it to give insurance companies more customers and a bigger bottom line?

8 Comments

Don’t you know it’s extremely easy to get the policy benefit and cost information? The highest individual deductible on the cheapest plan is $5000, $10000 for family. There simply is no $6000 individual deductible, let alone an average one.

You don’t pay the deductible before benefits kick in, most benefits are associated with a co-pay. The maximum out of pocket (again for the cheapest plan) is $6250 for an individual. If you don’t want a high deductible or co-pay then you get a more expensive plan.

Most people qualify for a tax credit to help them with their premiums. Did you shop for individual policies before the ACA? I did, and deductibles and co-pays were more, as were the premiums.

As far as the other complaints such as doctors being out of network – well, welcome to the world of health insurance. The ACA didn’t create that… it’s always been that way. You have a plan, some doctors are in network, some are out of network. It’s been that way for company sponsored plans also.

There were literally hundreds of ACA horror stories during the rollout and all of them were dis-proven. I guess we can add one more to the list.

“””
“Of those Californians who were uninsured prior to open enrollment, 58 percent now report having health insurance, which translates to about 3.4 million previously uninsured adult Californians who have gained coverage, and 42 percent say they remain uninsured.1 The most common source of coverage was Medi-Cal with 25 percent of previously uninsured Californians reporting they are now covered by Medi-Cal. An additional 9 percent of California’s previously uninsured say they enrolled in a plan through Covered California, resulting in about a third reporting new coverage from the two sources most directly tied to the ACA. Twelve percent say they obtained coverage through an employer and 5 percent report enrolling in non-group plans outside of the Covered California Marketplace; some enrollment in these types of coverage may have been motivated by the ACA’s requirement to purchase insurance and some may be the result of normal movement within the marketplace.”
“””

After controlling for a number of demographic factors, the remaining uninsured are more likely to be male, undocumented immigrants, or people who have never had insurance, while those who are newly insured are more likely to be married, have been uninsured for less than two years, have a debilitating chronic condition or report being contacted about signing up for coverage.

Inge’s research may not be the best one to encompass the ACA scope, but she raises good points. At the macro level the jury is still out, but it seems that the balance is tilting towards accepting the reform as positive relatively to the previous health care system.

There are still a lot of valid complaints about the slow improvement of the administration of the ACA, and CoveredCA is not an exception. I have heard from friends who works in Orange County agencies that there is a backlog of 50,000 applications in the county alone, since the enrollment period which ended in March. They are working hard but then they encounter problems like resetting their passwords to access the Covered California system may take weeks. If anybody from Loretta Sanchez’s office reads this blog, maybe they could contact CoveredCA and help to expedite basic operational problems.